What is the difference between Medicare and Medicare Advantage?
Asked by: Samara Rowe | Last update: August 23, 2023Score: 4.9/5 (63 votes)
Original Medicare covers inpatient hospital and skilled nursing services – Part A - and doctor visits, outpatient services and some preventative care – Part B. Medicare Advantage plans cover all the above (Part A and Part B), and most plans also cover prescription drugs (Part D).
What are the main differences between Medicare and Medicare Advantage?
Medicare Advantage plans cover all the same services under Original Medicare Part A and Part B, but often include prescription drug coverage and extra benefits. Some benefits may provide coverage for: Routine dental care (dental exams, X-rays, teeth cleanings) Routine vision care (eye exams, eyeglasses and contacts)
Is a Medicare Advantage plan the same as a Medicare Supplement?
A Medigap policy is different from a Medicare Advantage Plan (Part C). A Medicare Advantage Plan is another way to get your Medicare coverage besides Original Medicare. A Medigap policy is a supplement to Original Medicare coverage.
Is Medicare Advantage cheaper than traditional Medicare?
Medicare Advantage can cost less than Original Medicare. That's because Medicare Advantage plans must have a maximum out-of-pocket limit. In 2023, the maximum for in-network services will be $8,300 and, for in- and out-of-network combined, $12,450. (The limits this year are $7,550 and $11,300.)
Why do so many older adults choose Medicare Advantage?
Many Medicare Advantage plans offer additional benefits, such as money toward dental or vision care, which isn't covered by original Medicare. About 1 in 4 people say extra benefits pushed them to choose Medicare Advantage, according to a survey by the Commonwealth Fund, a health care think tank.
The Difference Between Medicare and Medicare Advantage
Can I switch from Medicare Advantage to original Medicare?
If you joined a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without a drug plan) within the first 3 months you have Medicare Part A & Part B.
Does Medicare pay anything if you have an Advantage plan?
Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you're in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you're always covered for emergency and urgent care.
Can I have both Medicare Supplement and Medicare Advantage?
Medicare Advantage (Part C) and Medicare Supplement plans help pay for costs not covered by Original Medicare (Parts A and B). However, they provide 2 different types of coverage, and you can't have both at the same time.
Is it necessary to have a Medicare Supplement?
Medicare supplement plans are optional but could save you big $$$ on doctor bills. Your cost-sharing under Part B is similar. You are responsible for paying your Part B deductible, which is $226 in 2023. Then Part B Medicare only pay 80% of approved services.
Why do people choose Medicare Advantage plans?
Under Medicare Advantage, you will get all the services you are eligible for under original Medicare. In addition, some MA plans offer care not covered by the original option. These include some dental, vision and hearing care. Some MA plans also provide coverage for gym memberships.
Are Medicare Advantage patients healthier?
Historically, Medicare Advantage beneficiaries have been healthier than those in the traditional program, but this seems to be changing: beneficiaries now have similar characteristics and experiences regardless of coverage.
How do I switch back to original Medicare?
If you're already in a Medicare Advantage plan and you want to switch to traditional Medicare, you should contact your current plan to cancel your enrollment and call 1-800-MEDICARE (1-800-633-4227). Note there are specific enrollment periods each year to do this.
Does a Medicare Advantage plan cover the 20 percent?
Copayment: MA Plans usually charge a copayment (copay) for doctor's visits, instead of the 20% coinsurance you pay under Original Medicare. Keep in mind that MA Plans cannot charge higher copays than Original Medicare for certain care, including chemotherapy, dialysis, and skilled nursing facility (SNF) care.
What are 3 types of Medicare Advantage plans?
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Special Needs Plans (SNPs)
Who pays for Medicare Part B?
Cost: If you have Part B, you pay a Part B premium each month. Most people will pay the standard premium amount. Social Security will contact some people who have to pay more depending on their income. If you don't sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty.
Do I have to pay for Medicare Part D if I have supplemental insurance?
You're required to pay the Part D IRMAA, even if your employer or a third party (like a teacher's union or a retirement system) pays for your Part D plan premiums. If you don't pay the Part D IRMAA and get disenrolled, you may also lose your retirement coverage and you may not be able to get it back.
How much is Medicare Part B?
Most people pay the standard Part B monthly premium amount ($164.90 in 2023). Social Security will tell you the exact amount you'll pay for Part B in 2023. You pay the standard premium amount if you: Enroll in Part B for the first time in 2023.
What are the rules to have a Medicare Advantage plan?
Who Qualifies for Medicare Advantage? You are eligible for a Medicare Advantage plan if you have Original Medicare (Part A and Part B). Even those on Medicare under 65 due to disability may enroll. You may sign up for a Medicare Advantage policy if you live in your chosen plan's service area.
Do Medicare Advantage plans have to accept everyone?
A Medicare Advantage (MA) Plan, known as Medicare Part C, provides Part A and B benefits, and sometimes Part D (prescription drugs), and other benefits. All Medicare Advantage providers must accept Medicare-eligible enrollees.
Can you be dropped from a Medicare Advantage plan?
Medicare Advantage plans may discontinue your Medicare Advantage coverage if you don't pay your premium within the grace period allowed by the Medicare Advantage plan. If you can't make your premium payment, you should contact your Medicare Advantage plan's customer service.
Can you cancel a Medicare Advantage plan at any time?
If you're in a Medicare Advantage plan with or without Part D coverage, you can: Switch to another Medicare Advantage plan with or without Part D coverage, OR. Disenroll from your plan and return to Original Medicare anytime between January 1 – March 31.
Do you have to re enroll in Medicare every year?
Unless you take action to change it during the Annual Enrollment Period, your current Medicare coverage will renew for the following year. Automatic renewal helps ensure that you will have continuing coverage.
How often can I switch from Medicare Advantage to Original Medicare?
Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 each year. Your coverage under traditional Medicare will begin January 1 of the following year.